General practicioners are under huge pressure and need support, not censure

SIR – We are extremely disappointed that our colleagues from the Royal College of Pathologists (Letters, July 1) are welcoming proposals to “name and shame” GPs on cancer referral rates.

To suggest that GPs are causing delays in diagnosis by not efficiently using the right blood tests is simplistic and does a great disservice to our profession. It is an insult to hard-working and hard-pressed GPs.

When GPs are under huge pressures, with patient demand far outstripping capacity, we believe that a collaborative approach is more likely to improve the care we can give to our patients.

A “name and shame” strategy is likely to decrease the threshold for referral and result in other parts of the NHS being swamped. This will ultimately lead to delays in patients receiving treatment and worse outcomes.

Timely diagnosis of cancer is a priority for the Royal College of General Practitioners and we are working hard to support GPs so that they can identify signs of cancer as early as possible and refer the patients they suspect of having cancer for the most appropriate tests.

Related Articles

The average full-time GP will see approximately eight new cases of cancer in their average 8,000 patient consultations per year, and 75 per cent of patients found to have cancer are referred after only one or two GP consultations.

There are 40 million more consultations in general practice today than there were even five years ago, and GPs are routinely working 11-hour days and seeing between 40 and 60 patients in a day.

The crisis in general practice is so severe that at least 27 million patients will have to wait more than a week to see a GP this year and 84 per cent of GPs are worried that their workloads are so high that they might miss something serious in a patient.

We are calling on all four governments in the United Kingdom to increase funding for general practice to 11 per cent from 8.3 per cent of the NHS budget, so that we can provide more GPs, more appointments and longer appointments.

General practice keeps the rest of the NHS strong and stable. We should be supporting our GPs, not criticising them.

Dr Maureen Baker Chairman, Royal College of General Practitioners London NW1

SIR – If there is a perception of delay in cancer diagnosis, real or otherwise, it is devastating for patients and their families but also soul-destroying for their GPs.

Sinister causes (including cancer) could explain just about any symptom in the average GP consultation. The risk of not finding that needle in the haystack is why GPs must pay thousands of pounds a year for liability insurance.

The NHS performs better than any health care system in the Western world - at a fraction of the cost of other countries - because British GPs hold the dual responsibility of caring for the patient in front of them and keeping the NHS alive within its monetary constraints by avoiding unnecessary referrals. GPs also seek to avoid delays which might adversely affect patients’ health.

If a doctor is negligent (and this might be by causing a delay in diagnosis), there are due processes that determine whether any wrong has been done – via the General Medical Council or courts.

Naming and shaming GPs who miss cancer diagnoses is a bullying tactic which lacks evidence of effectiveness. GPs will pre-empt this by referring so many patients for tests that those who do have cancer will lose out and the NHS will be bankrupted.

This attack on British general practice is not based on fact. Only 10 per cent of cancer patients needed more than five appointments before being referred for a cancer diagnosis. No fewer than two thirds are diagnosed at the first GP consultation.